This site is intended for healthcare professionals only

The Diabetic
Foot Journal


Share this article

Digest: When socks don’t just cover the feet

Neil Baker
Dear readers, the paper I want to bring to your attention is by Soh et al from Malaysia, however, I would suggest that you also take time to read the systematic review on ulcer prevention by van Netten et al, alongside this. The evidence for first ulcer prevention interventions is very poor but we know that correct footwear, insoles and regular podiatry underpinned with health education is beneficial. Of course, the largest downfall with these interventions is that they perhaps do not address that the majority of weightbearing time is spent indoors.

The study by Soh et al was a non-randomised prospective study, examining the use of pressure- relieving StepEase™ socks worn indoors over a 12-week period. StepEase diabetic socks contain pockets of Ethylene Vinyl Acetate (EVA) microspheres within a cotton/lycra sock aimed to provide plantar pressure redistribution. The EVA microspheres mould to the contours of the plantar surface of the feet similar to a sand footprint. The objective of this study was to determine the plantar pressure efficacy of StepEase socks and to assess patients’ satisfaction. Thirty-two subjects with a mean age and BMI of 57.9 years and 26 kg/m2, respectively, deemed to have ‘high risk’ feet were recruited to this study. The paper does not specify how high risk was determined exactly but states either sensory neuropathy or ischaemia were present. The former was determined by inability to feel a 10 g monofilament at one or more sites but the sites for testing were not described. No criteria were described for determining the presence of ischaemia. Study exclusion criteria were who could not stand or walk, had major or minor amputation, severe deformity, poor cognitive function, dementia or psychiatric conditions. Demographic data, diabetes and medical history, diabetes mellitus control, type of footwear and usual activity levels were recorded by a questionnaire. Activity levels was classified into high (hiking, jogging), moderate (outdoor walking, household cleaning) and low (limited to household activities).
Dynamic plantar pressure readings both barefoot and with StepEase socked feet were recorded at day 0, 6 weeks and 12 weeks using the Novel Pedar-X pressure plate system. Patients’ satisfaction and sock usage practice were recorded by questionnaire.The socks were worn for a mean of 4.39 days per week (SD 1.82). The highest mean peak plantar pressures were in the right forefoot, 267.6 kPa (SD113.5 kPa) and left heel region 266.3 kPa (SD 94.6 kPa). The highest reduction was seen in the right toe region (47.5%). Mean peak pressures reduced significantly with a reduction range (53.2–117.4 kPa) of between from 22.3% to 47.5% (P<0.0001 to P=0.024) in all masked regions except the left toe region. At 6 weeks, the significant peak pressure reduction range was sustained (46.1–100.6 kPa) of between 24.7% to 46.8% (P<0.0001 to P=0.034) and also at 12 weeks, which was 22.2% to 49.2% (40.6–91.9 kPa). Most of the subjects were satisfied or very satisfied with the StepEase socks (77.4%), while 87.1% agreed to continue using the socks. No new ulcers or any falls occurred during the study period.

Although this study is limited in several ways, it brings a focusing thought to managing preventative offloading in everyday life at home. This is a neglected area of prevention.

Related content
A good sense of EWMA
Understanding personality traits: could this help us support better foot self-care behaviours in people with diabetes?
Amputation inequalities across a large metropolitan area of England and effect of a ‘high-risk’ rather than ‘diabetes-only’ multidisciplinary approach to lower-limb wound care 2015/16 to 2021/22
Free for all UK & Ireland healthcare professionals

Sign up to all DiabetesontheNet journals


By clicking ‘Subscribe’, you are agreeing that are able to email you periodic newsletters. You may unsubscribe from these at any time. Your info is safe with us and we will never sell or trade your details. For information please review our Privacy Policy.

Are you a healthcare professional? This website is for healthcare professionals only. To continue, please confirm that you are a healthcare professional below.

We use cookies responsibly to ensure that we give you the best experience on our website. If you continue without changing your browser settings, we’ll assume that you are happy to receive all cookies on this website. Read about how we use cookies.